WSJ article on smallpox vaccinations
Dec. 18th, 2002 04:35 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
jenkInteresting info, especially the notes that the vaccine is effective even if administered days after exposure & that smallpox isn't as contagious as flu. Saved for future reference.
Bush's Smallpox Advice:
Don't Follow My Lead
President Bush says he will soon be vaccinated against smallpox. But he says most Americans should not get a shot when the vaccine is available in a few months, although those who insist on being inoculated will be able to do so for free at designated clinics.
That may leave many Americans confused about what they should do for themselves. But health experts say they shouldn't be. Their advice is that the vast majority of Americans not get vaccinated now. Put simply, they argue, the public-health risks associated with the vaccine outweigh its protective benefits.
Still, many people are understandably alarmed by the threat of the dread disease. In a democratic society in which people feel they should have unhindered access to the best health care available, Mr. Bush and other politicians certainly are right to let everyone make his or her own decision about whether to be vaccinated. Public-health experts see their role differently. Their job is to provide the facts, no matter how complex they are, that let the rest of us make common-sense decisions.
As a result, the nation's health leaders, notably the U.S. Centers for Disease Control and Prevention and numerous physician associations, are taking an unambiguous stand. A new vaccine is currently being tested and likely to be available in late 2004. Until then, when a major government-funded education campaign will be rolled out, there is no compelling reason to rush out and be inoculated with the existing but older vaccine that will be widely available early next year.
The White House's Plan
The Bush administration's most recent policy was announced late last week, when it was determined that there would soon be enough vaccine for every American. In its announcement, the administration said it will begin vaccinating some 500,000 military personnel and other overseas government staffers. Soon after that, as many as 10 million other Americans deemed at high risk in the event of a terrorist attack will be vaccinated. Initially, the vaccine will be given to the volunteer smallpox-response teams made up of health-care workers that are being organized in each state to provide care in an attack. In the months to follow, the vaccine also will be provided to so-called "first responders" -- emergency workers such as police officers and firefighters, who have a high risk of coming into contact with those exposed to the virus.
As commander-in-chief of the armed forces, the president feels compelled to take the same action he is proposing for those most likely to be in harm's way. But government officials are also stating forthrightly that there is "no imminent threat" of an attack. They say there is no firm evidence that terrorist groups or dangerous governments, such as Iraq's, have supplies of the virus or a means to spread it.
Indeed, while smallpox is a dangerous virus, it's not nearly as contagious as the flu, the common cold, or chicken pox. In past outbreaks -- and there hasn't been a natural one anywhere since 1977 -- infections were limited mostly to family members or health workers in direct contact with an infected person. It's also worth remembering that even in those outbreaks, the virus was lethal only about 30% of the time. Among healthy Americans with robust immune systems, that mortality rate might be even lower.
Which Risk?
Mass inoculations are certain to cause some illnesses, and maybe even deaths. The vaccine is made from a related pox virus called vaccinia that is administered via a needle prick to the skin. Within about three days, the immune system of most people will be able to ward off the virus. It's important to know that vaccinations given four to seven days after exposure can either protect against illness or reduce the severity of disease. Those vaccinated will be protected for three to five years, and partially protected even longer.
But past experience suggests that for about every million people vaccinated, 1,000 may suffer serious but not life-threatening reactions -- such as headache, fatigue, muscle aches or chills -- for a week or so. And studies warn that between 14 and 52 of those million vaccinated will get seriously ill, and about one or two will die. Exposure to the vaccinia virus is especially dangerous to anyone with a weakened immune system, a group that includes anyone who has received a transplant, is HIV-positive, is being treated for cancer, or lives with anyone with one of those conditions. Such folks could even get ill if they come in close contact with someone inoculated within the last few days.
Moreover, on www.smallpox.gov4, an informational Web site put up late last week by the Department of Health and Human Services, the government strongly advises that unless they are directly exposed to smallpox or at high risk of exposure, pregnant women, breastfeeding mothers, and anyone under 18 shouldn't even consider getting vaccinated. The newer vaccine, being developed by the U.K.'s Acambis PLC and Baxter International Inc., will be manufactured somewhat differently than the existing vaccine and may have a lower incidence of side effects, though that won't be known until the current trial is completed about a year from now.
Given all this, the CDC's Advisory Committee on Immunization Practices has told state response teams that in the event of an outbreak they should use a "ring vaccination" strategy designed to "search and contain" the virus. In this strategy, those in contact with people infected with smallpox and those who have in turn contacted the contacts will be vaccinated immediately. Because the vaccine is effective within three or four days of exposure, there is reason to believe an outbreak can be minimized without the need for everyone to be inoculated.
But even health policymakers realize that some folks who are especially worried about a potential terrorist attack are going to want to be immunized. It's important that these folks better understand both the low risk of the smallpox threat and the very real risk vaccinations pose. While it is clear that a concerted effort is now under way to ensure Americans will be protected should there ever be such an attack, much more needs to be done to help people make educated decisions before an attack occurs.
Write to Mike Waldholz at mike.waldholz@wsj.com
Bush's Smallpox Advice:
Don't Follow My Lead
President Bush says he will soon be vaccinated against smallpox. But he says most Americans should not get a shot when the vaccine is available in a few months, although those who insist on being inoculated will be able to do so for free at designated clinics.
That may leave many Americans confused about what they should do for themselves. But health experts say they shouldn't be. Their advice is that the vast majority of Americans not get vaccinated now. Put simply, they argue, the public-health risks associated with the vaccine outweigh its protective benefits.
Still, many people are understandably alarmed by the threat of the dread disease. In a democratic society in which people feel they should have unhindered access to the best health care available, Mr. Bush and other politicians certainly are right to let everyone make his or her own decision about whether to be vaccinated. Public-health experts see their role differently. Their job is to provide the facts, no matter how complex they are, that let the rest of us make common-sense decisions.
As a result, the nation's health leaders, notably the U.S. Centers for Disease Control and Prevention and numerous physician associations, are taking an unambiguous stand. A new vaccine is currently being tested and likely to be available in late 2004. Until then, when a major government-funded education campaign will be rolled out, there is no compelling reason to rush out and be inoculated with the existing but older vaccine that will be widely available early next year.
The White House's Plan
The Bush administration's most recent policy was announced late last week, when it was determined that there would soon be enough vaccine for every American. In its announcement, the administration said it will begin vaccinating some 500,000 military personnel and other overseas government staffers. Soon after that, as many as 10 million other Americans deemed at high risk in the event of a terrorist attack will be vaccinated. Initially, the vaccine will be given to the volunteer smallpox-response teams made up of health-care workers that are being organized in each state to provide care in an attack. In the months to follow, the vaccine also will be provided to so-called "first responders" -- emergency workers such as police officers and firefighters, who have a high risk of coming into contact with those exposed to the virus.
As commander-in-chief of the armed forces, the president feels compelled to take the same action he is proposing for those most likely to be in harm's way. But government officials are also stating forthrightly that there is "no imminent threat" of an attack. They say there is no firm evidence that terrorist groups or dangerous governments, such as Iraq's, have supplies of the virus or a means to spread it.
Indeed, while smallpox is a dangerous virus, it's not nearly as contagious as the flu, the common cold, or chicken pox. In past outbreaks -- and there hasn't been a natural one anywhere since 1977 -- infections were limited mostly to family members or health workers in direct contact with an infected person. It's also worth remembering that even in those outbreaks, the virus was lethal only about 30% of the time. Among healthy Americans with robust immune systems, that mortality rate might be even lower.
Which Risk?
Mass inoculations are certain to cause some illnesses, and maybe even deaths. The vaccine is made from a related pox virus called vaccinia that is administered via a needle prick to the skin. Within about three days, the immune system of most people will be able to ward off the virus. It's important to know that vaccinations given four to seven days after exposure can either protect against illness or reduce the severity of disease. Those vaccinated will be protected for three to five years, and partially protected even longer.
But past experience suggests that for about every million people vaccinated, 1,000 may suffer serious but not life-threatening reactions -- such as headache, fatigue, muscle aches or chills -- for a week or so. And studies warn that between 14 and 52 of those million vaccinated will get seriously ill, and about one or two will die. Exposure to the vaccinia virus is especially dangerous to anyone with a weakened immune system, a group that includes anyone who has received a transplant, is HIV-positive, is being treated for cancer, or lives with anyone with one of those conditions. Such folks could even get ill if they come in close contact with someone inoculated within the last few days.
Moreover, on www.smallpox.gov4, an informational Web site put up late last week by the Department of Health and Human Services, the government strongly advises that unless they are directly exposed to smallpox or at high risk of exposure, pregnant women, breastfeeding mothers, and anyone under 18 shouldn't even consider getting vaccinated. The newer vaccine, being developed by the U.K.'s Acambis PLC and Baxter International Inc., will be manufactured somewhat differently than the existing vaccine and may have a lower incidence of side effects, though that won't be known until the current trial is completed about a year from now.
Given all this, the CDC's Advisory Committee on Immunization Practices has told state response teams that in the event of an outbreak they should use a "ring vaccination" strategy designed to "search and contain" the virus. In this strategy, those in contact with people infected with smallpox and those who have in turn contacted the contacts will be vaccinated immediately. Because the vaccine is effective within three or four days of exposure, there is reason to believe an outbreak can be minimized without the need for everyone to be inoculated.
But even health policymakers realize that some folks who are especially worried about a potential terrorist attack are going to want to be immunized. It's important that these folks better understand both the low risk of the smallpox threat and the very real risk vaccinations pose. While it is clear that a concerted effort is now under way to ensure Americans will be protected should there ever be such an attack, much more needs to be done to help people make educated decisions before an attack occurs.
Write to Mike Waldholz at mike.waldholz@wsj.com
